Delineation guidelines for the lymphatic target volumes in 'prone crawl' radiotherapy treatment position for breast cancer patients.

Our recently developed prone crawl position (PCP) for radiotherapy of breast cancer patients with lymphatic involvement showed promising preliminary data and it is being optimized for clinical use. An important aspect in this process is making new, position specific delineation guidelines to ensure delineation (for treatment planning) is uniform across different centers. The existing ESTRO and PROCAB guidelines for supine position (SP) were adapted for PCP. Nine volunteers were MRI scanned in both SP and PCP. Lymph node regions were delineated in SP using the existing ESTRO and PROCAB guidelines and were then translated to PCP, based on the observed changes in reference structure position. Nine PCP patient CT scans were used to verify if the new reference structures were consistently identified and easily applicable on different patient CT scans. Based on these data, a team of specialists in anatomy, CT- and MRI radiology and radiation oncology postulated the final guidelines. By taking the ESTRO and PROCAB guidelines for SP into account and by using a relatively big number of datasets, these new PCP specific guidelines incorporate anatomical variability between patients. The guidelines are easily and consistently applicable, even for people with limited previous experience with delineations in PCP.

Breast implant seroma: A SARS-CoV-2 mRNA vaccine side effect.

Fluid collection surrounding breast implants, called seroma, is a frequent issue that has diverse etiologies. We describe a 48-year-old woman with an acute onset of bilateral breast swelling occurring 5 years after aesthetic surgery and 10 days after a second SARS-CoV-2 mRNA vaccine dose. At breast ultrasound, we found an abundant bilateral peri-implant seroma. Our patient noticed symptom improvement 48 h after nonsteroidal anti-inflammatory drug treatment, complete disappearance of symptoms after 10 days with seroma disappearance documented by ultrasound. We hypothesized a breast implant seroma as post-SARS-CoV-2 mRNA vaccine side effect, as different other diagnosis had been excluded.

Inconclusive triple diagnosis in breast cancer imaging: is there a place for scintimammography?

UNLABELLED: Scintimammography (SM) can be used as a complementary test to mammography in patients with suspected breast cancers. This study was undertaken to evaluate the impact of SM on the management of patients with a doubtful or discordant triple diagnosis-that is, mammography, ultrasound, and fine-needle aspiration cytology. The clinical question was variable: initial diagnosis of cancer, suspicion of recurrence, doubtful tumor extension, or search for a primary tumor. METHODS: We performed a retrospective study of 118 procedures in 104 patients with a suggestion of breast cancer, either at initial presentation or after treatment (relapse), with an inconclusive triple diagnosis. Planar and tomographic imaging was performed after injection of (99m)Tc-labeled methoxyisobutylisonitrile ((99m)Tc-MIBI). Results were compared with histopathologic analysis (surgery or core biopsy) in 82 cases and with clinical and imaging follow-up in 36 cases. RESULTS: Breast cancer was proven in 69 cases. SM-SPECT had a sensitivity of 88.4% and a specificity of 67%. Eleven cancers were detected by SPECT, although planar images were negative. SM-SPECT was more sensitive in patients scanned at initial presentation (95%) than in those with suspected recurrence (81%). SM-SPECT correctly evaluated multicentricity or bilaterality in 8 of 11 patients and resulted in an increased tumor size in 8 patients. Overall, SM-SPECT modified the patient management in 58 of 118 cases (49%): SM made the diagnosis of cancer in 30 cases with doubtful or discordant triple diagnosis and ruled out malignancy in 28 cases. CONCLUSION: SM-SPECT is a useful complementary tool for the diagnosis and evaluation of disease extent in patients with an inconclusive triple diagnosis including fine-needle aspiration. The procedure altered the patient management in 49% of the population. These results must be confirmed in a prospective trial.